GET TO KNOW YOUR OPTIONS
It's important to choose the plan that's right for your unique needs. Both plans fully cover in-network preventive care, but there are plenty of differences.
Our PPO plan
Includes our national network of providers
No primary care provider (PCP) or referrals required
Lower cost per paycheck and higher deductible
Billed 100% of the charges until the deductible is met
Auto-enrolled in an HSA
Our HMO plan
Includes our New England network of providers
PCP and referrals to see specialists required
Slightly higher cost per paycheck and lower deductible
Copay needed for most medical services and purchasing prescriptions
Auto-enrolled in an HRA
How you pay for a covered service depends on the plan you choose. To better understand what’s owed
and whether you might pay at your appointment or later on, read these examples of our plans in action.
“I’ve selected the PPO Saver plan every year for my family. We appreciate the balance of cost savings and comprehensive coverage. I highly recommend the PPO Saver Plan to anyone looking for a flexible and affordable health care solution."
Colleen Williams
Your colleague on the enterprise risk management team
PLAN COST COMPARISON
Associates with an annualized base salary less than $80,000
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Annual Deductible | Individual: $1,700 Individual +1: $3,400 Family: $3,400 | Individual: $1,350 Individual +1: $2,700 Family: $2,700 |
| Paycheck Contributions | Individual: $32.87 Individual +1: $65.30 Family: $95.00 | Individual: $53.47 Individual +1: $106.42 Family: $155.25 |
| Contributions from Blue Cross | Individual: $1,225 Individual +1: $2,450 Family: $2,450 | Individual: $400 Individual +1: $800 Family: $1,000 |
| Net Deductible: the remaining balance of your deductible after using Blue Cross contributions | Individual: $475 Individual +1: $950 Family: $950 | Individual: $950 Individual +1: $1,900 Family: $1,700 |
| Out-of-Pocket Maximum | Individual: $5,000 Individual +1: $10,000 Family: $10,000 | Individual: $3,000 Individual +1: $6,000 Family: $6,000 |
Associates with an annualized base salary of $80,000 or more
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Annual Deductible | Individual: $1,700 Individual +1: $3,400 Family: $3,400 | Individual: $1,350 Individual +1: $2,700 Family: $2,700 |
| Paycheck Contributions | Individual: $50.69 Individual +1: $100.89 Family: $147.94 | Individual: $75.44 Individual +1: $150.30 Family: $220.40 |
| Contributions from Blue Cross | Individual: $850 Individual +1: $1,700 Family: $1,700 | Individual: $400 Individual +1: $800 Family: $1,000 |
| Net Deductible: the remaining balance of your deductible after using Blue Cross contributions | Individual: $850 Individual +1: $1,700 Family: $1,700 | Individual: $950 Individual +1: $1,900 Family: $1,700 |
| Out-of-Pocket Maximum | Individual: $5,000 Individual +1: $10,000 Family: $10,000 | Individual: $3,000 Individual +1: $6,000 Family: $6,000 |
How Blue Cross helps pay toward your deductible
With each plan, you get a health financial account that Blue Cross contributes to. You can use these funds from Blue Cross to pay for eligible expenses that would otherwise be out-of-pocket costs before you meet your deductible. The deductible amount left over after you subtract the Blue Cross contributions is your net deductible. Refer to the amounts in the chart above to find your own.
Example:
Pat needs family coverage and has an annualized base salary of less than $80,000. Based on the rates in the chart above, here’s how Pat would find the net deductible for each plan.
Based on the rates in the chart above, see how Pat would find the Net Deductible for each plan.
| PPO Plan | HMO Plan | |
|---|---|---|
| Annual Deductible | $3,400 | $2,700 |
| Subtract Contributions by Blue Cross | $2,250 | $1,000 |
| Net Deductible | $950 | $1,700 |
“The Blue Cross-funded HRA was a big help when I needed an MRI of my hand. Having it enabled me to focus on what I needed to do to heal rather than the cost of the service."
Michael Steinhardt
Your colleague in Sales
COSTS FOR MEDICAL SERVICES
Co-insurance/copayments
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Your Cost | You must meet the deductible amount first, then you’ll pay 10% co-insurance (when required) | $25-$150 copayments (specific services subject to deductible) |
Medical
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Preventive Care | $0, no deductible | $0, no deductible |
| Emergency Room (ER) | Deductible, then $150 copay1 | $150 copay, no deductible1 |
| Urgent Care | Deductible, then co-insurance | $35 copay, no deductible |
| PCP Visit | Deductible, then co-insurance | $25 copay, no deductible |
| Specialist Visit | Deductible, then co-insurance | $35 copay, no deductible3 |
Hospital Care
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Inpatient/Outpatient | Deductible, then co-insurance1, 2 | Deductible, then $01 |
Tests
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Diagnostics (X-rays, lab tests) | Deductible, then co-insurance | Deductible, then $0 |
| Imaging (CT/PET Scans, MRIs) | Deductible, then co-insurance2, 4 | Deductible, then $75 copay2, 4 |
Mental Health or Substance Use Disorder
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Inpatient | Deductible, then co-insurance2 | Deductible, then $02 |
| Outpatient | Deductible, then co-insurance | $25 copay, no deductible |
Pregnancy Care
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Prenatal | $0, no deductible | $0, no deductible |
| Postnatal | Deductible, then co-insurance | $0, no deductible |
| Inpatient (including delivery) | Deductible, then co-insurance | Deductible, then $0 |
Telehealth
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Minor medical care | Deductible, then co-insurance | $25 copay, no deductible |
| Therapy | Deductible, then co-insurance | $25 copay, no deductible |
| Psychiatry | Deductible, then co-insurance | $25 copay, no deductible |
1. Copay waived if admitted or for observation stay.
2. Prior authorization required.
3. Under this plan, you're required to select a PCP and will need a referral from your PCP to see a specialist.
4. Coverage and cost-sharing limitations and/or exceptions may apply. Visit bluecrossma.org/associate to see the Summary of Benefits and Coverage for more information.